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Was everything we had hoped for and more. The property is first class accommodations with plenty of room and modern appliances. Only a 5 minute drive to Montepulciano. Stunning views at every turn. Great value. We will return.
Was as good as in the photos. Adrian, the owner is helpful and even baked us a delicious Lemon Drizzle cake for which he gave us the recipe!
Beautiful vistas from the villa, we had 2 BBQs as weather was lovely. '
Nice hamper with Vino Nobile di Montepulciano wine when we arrived
Nice and quiet -- all you hear...
A friend rented this lovely Tuscan home for 2 weeks in April. She invited friends to go with her, and are we lucky to be friends! This is a marvelous location, your view of Montepulciano is just outside the door. The house is large, comfortable, a great kitchen, even an outdoor pizza oven we used a couple of times! Adrian...
We just came back from staying for a week at this villa with two other couples. The villa is beautiful with a full view to Montepulciano, tastfully decorated and very comfortable. Adrian and his family went all out to make sure our trip experience to the area was awesome! His three girls and wife made sure we were always comfortable...
We were a group of 5 friends who spent a week at La Casina in early October. We used 3 of the 4 bedrooms, each with it's own bathroom, and spent lots of time in the kitchen and outside on the patio. The bedrooms are large and private, the kitchen perfect for cooking wonderful meals and spending time visiting around...
We're just back from spending only six nights at La Casina. This was really too short. I would have liked to spend at least two weeks there.
Getting to La Casina will be a challenge for first timers especially if they are city dwellers. The roadway poses not such a big problem but the last mile or two to La...
Great location and very nice villa. Thank you Adrian and family!
We have just left after a fantastic trip to La Casina and could not wait to write a review. This was our second trip to the region and it was for a family reunion and Adrian and Gill made this one to remember. Then things that we really loved about the villa were as follows:
1. Standard of the Villa,...


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July 03, 2015
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|By Business Wire
Article Rating:
|November 8, 2012 05:30 AM EST
Rackwise, Inc. (RACK.OB) (the "Company"), a leading developer of data center infrastructure management ("DCIM") software and service solutions, today announced that Data Intensity, Inc. ("Data Intensity"), headquartered in Bedford, MA, is expanding deployment of Rackwise DCiM XTM to manage the information technology ("IT") infrastructure that is the backbone of Data Intensity's enterprise software hosting and application management solutions business.
One of the fastest growing and leading providers in their space, Data Intensity is a cloud services and application management company focused on Oracle ERP platforms. Data Intensity's dynamic and scalable hosting computing solutions require sophisticated DCIM software to effectively manage their IT infrastructure to both meet customers' needs as well as optimize the cost and operational efficiencies of Data Intensity's computing ecosystems. Their recent move to a remote co-located data center and increasing rack count combined with the rapid expansion of Data Intensity's business drives the need for improved asset visualization and capacity planning capabilities, providing continuous monitoring to quickly and efficiently address client needs. With its suite of advanced features and functionalities, Rackwise DCiM XTM enables Data Intensity to easily identify and track asset location and other critical data remotely, facilitating Smart Hands and similar mobile offsite management technologies for maximum flexibility and quick action. Rackwise DCiM XTM is a key component in Data Intensity's strategy for managing and providing a robust IT environment while continually optimizing data center capacity, operational efficiencies and costs to meet the needs of their rapidly expanding customer base.
Mr. Guy A. Archbold, Rackwise, Inc. Chief Executive Officer, added, "Companies around the world rely on Data Intensity for cloud-based hosting and application management services for their critical ERP platforms. We are delighted that our Rackwise DCiM XTM solution is included as a key element in Data Intensity's strategic plan to deliver cloud-driven solutions to their global customer base. They are among a growing number of clients and IT professionals utilizing our offerings to efficiently and effectively plan, manage, and control their data centers and computing infrastructures to achieve the highest levels of operational efficiency and cost optimization by assuring reliability, discovering hidden capacity, and enabling efficiencies across their IT landscape."
About Rackwise, Inc.
Rackwise, Inc. (RACK.OB) is a leader in software development and marketing within the growing data center infrastructure management ("DCIM") market for IT infrastructure tracking, monitoring, modeling, and management. The Company's flagship product, Rackwise DCiM XTM, incorporates open architecture designs into a vendor agnostic platform affording IT professionals maximum flexibility for efficient integration in any computing environment. The Rackwise DCiM XTM offering provides features and functionalities to assure reliability, identify hidden capacity, and improve efficiencies resulting in accelerated returns on investments through significantly optimized data center facilities and IT infrastructures. Rackwise DCiM XTM integrates device level, real-time monitoring with advanced modeling, reporting, analytics and other critical capabilities, enabling clients to more effectively manage today's high density computing configurations and virtualized data centers, mitigate risks associated with cascading faults and other potential inefficiencies within the infrastructure, and facilitate progress to more sustainable "green" data centers. Rackwise® products and services are used by over 150 companies worldwide. For more information, visit www.rackwise.com.
Rackwise®, DCiMTM and DCiM XTM are trademarks of Rackwise, Inc. Other designated trademarks and brands mentioned herein are the property of their respective owners.
Safe Harbor Statement
Any statements contained in this press release that do not describe historical facts may constitute forward-looking statements as that term is defined in the Private Securities Litigation Reform Act of 1995. Any forward-looking statements contained herein are based on current expectations, but are subject to a number of risks and uncertainties. The factors that could cause actual future results to differ materially from current expectations include, but are not limited to, risks and uncertainties relating to the availability of additional funding; and the Company's business, product development, marketing and distribution plans and strategies. These and other factors are identified and described in more detail in the Company's filings with the SEC, including, the Company's current reports on Form 8-K. The Company does not undertake to update these forward-looking statements.
Nowadays, a large number of sensors and devices are connected to the network. Leading-edge IoT technologies integrate various types of sensor data to create a new value for several business decision scenarios. The transparent cloud is a model of a new IoT emergence service platform. Many service providers store and access various types of sensor data in order to create and find out new business values by integrating such data.
Oct. 9, 2015 04:00 AM EDT Reads: 561
The buzz continues for cloud, data analytics and the Internet of Things (IoT) and their collective impact across all industries. But a new conversation is emerging - how do companies use industry disruption and technology enablers to lead in markets undergoing change, uncertainty and ambiguity? Organizations of all sizes need to evolve and transform, often under massive pressure, as industry lines blur and merge and traditional business models are assaulted and turned upside down. In this new data-driven world, marketplaces reign supreme while interoperability, APIs and applications deliver un...
Oct. 9, 2015 04:00 AM EDT Reads: 281
The broad selection of hardware, the rapid evolution of operating systems and the time-to-market for mobile apps has been so rapid that new challenges for developers and engineers arise every day. Security, testing, hosting, and other metrics have to be considered through the process. In his session at Big Data Expo, Walter Maguire, Chief Field Technologist, HP Big Data Group, at Hewlett-Packard, will discuss the challenges faced by developers and a composite Big Data applications builder, focusing on how to help solve the problems that developers are continuously battling.
Oct. 9, 2015 04:00 AM EDT Reads: 497
There are so many tools and techniques for data analytics that even for a data scientist the choices, possible systems, and even the types of data can be daunting. In his session at @ThingsExpo, Chris Harrold, Global CTO for Big Data Solutions for EMC Corporation, will show how to perform a simple, but meaningful analysis of social sentiment data using freely available tools that take only minutes to download and install. Participants will get the download information, scripts, and complete end-to-end walkthrough of the analysis from start to finish. Participants will also be given the pract...
Oct. 9, 2015 03:00 AM EDT Reads: 291
WebRTC services have already permeated corporate communications in the form of videoconferencing solutions. However, WebRTC has the potential of going beyond and catalyzing a new class of services providing more than calls with capabilities such as mass-scale real-time media broadcasting, enriched and augmented video, person-to-machine and machine-to-machine communications. In his session at @ThingsExpo, Luis Lopez, CEO of Kurento, will introduce the technologies required for implementing these ideas and some early experiments performed in the Kurento open source software community in areas ...
Oct. 9, 2015 03:00 AM EDT Reads: 720
Internet of Things (IoT) will be a hybrid ecosystem of diverse devices and sensors collaborating with operational and enterprise systems to create the next big application. In their session at @ThingsExpo, Bramh Gupta, founder and CEO of robomq.io, and Fred Yatzeck, principal architect leading product development at robomq.io, discussed how choosing the right middleware and integration strategy from the get-go will enable IoT solution developers to adapt and grow with the industry, while at the same time reduce Time to Market (TTM) by using plug and play capabilities offered by a robust IoT ...
Oct. 9, 2015 02:00 AM EDT Reads: 2,210
Today's connected world is moving from devices towards things, what this means is that by using increasingly low cost sensors embedded in devices we can create many new use cases. These span across use cases in cities, vehicles, home, offices, factories, retail environments, worksites, health, logistics, and health. These use cases rely on ubiquitous connectivity and generate massive amounts of data at scale. These technologies enable new business opportunities, ways to optimize and automate, along with new ways to engage with users.
Oct. 9, 2015 02:00 AM EDT Reads: 165
The Internet of Things (IoT) is growing rapidly by extending current technologies, products and networks. By 2020, Cisco estimates there will be 50 billion connected devices. Gartner has forecast revenues of over $300 billion, just to IoT suppliers. Now is the time to figure out how you'll make money – not just create innovative products. With hundreds of new products and companies jumping into the IoT fray every month, there's no shortage of innovation. Despite this, McKinsey/VisionMobile data shows "less than 10 percent of IoT developers are making enough to support a reasonably sized team....
Oct. 9, 2015 02:00 AM EDT Reads: 206
"In the past year we've seen a lot of stabilization of WebRTC. You can now use it in production with a far greater degree of certainty. A lot of the real developments in the past year have been in things like the data channel, which will enable a whole new type of application," explained Peter Dunkley, Technical Director at Acision, in this SYS-CON.tv interview at @ThingsExpo, held Nov 4–6, 2014, at the Santa Clara Convention Center in Santa Clara, CA.
Oct. 9, 2015 01:45 AM EDT Reads: 7,022
Through WebRTC, audio and video communications are being embedded more easily than ever into applications, helping carriers, enterprises and independent software vendors deliver greater functionality to their end users. With today's business world increasingly focused on outcomes, users' growing calls for ease of use, and businesses craving smarter, tighter integration, what's the next step in delivering a richer, more immersive experience? That richer, more fully integrated experience comes about through a Communications Platform as a Service which allows for messaging, screen sharing, video...
Oct. 9, 2015 12:00 AM EDT Reads: 1,133
SYS-CON Events announced today that Dyn, the worldwide leader in Internet Performance, will exhibit at SYS-CON's 17th International Cloud Expo®, which will take place on November 3-5, 2015, at the Santa Clara Convention Center in Santa Clara, CA. Dyn is a cloud-based Internet Performance company. Dyn helps companies monitor, control, and optimize online infrastructure for an exceptional end-user experience. Through a world-class network and unrivaled, objective intelligence into Internet conditions, Dyn ensures traffic gets delivered faster, safer, and more reliably than ever.
Oct. 8, 2015 10:00 PM EDT Reads: 593
The IoT market is on track to hit $7.1 trillion in 2020. The reality is that only a handful of companies are ready for this massive demand. There are a lot of barriers, paint points, traps, and hidden roadblocks. How can we deal with these issues and challenges? The paradigm has changed. Old-style ad-hoc trial-and-error ways will certainly lead you to the dead end. What is mandatory is an overarching and adaptive approach to effectively handle the rapid changes and exponential growth.
Oct. 8, 2015 09:00 PM EDT Reads: 118
Mobile messaging has been a popular communication channel for more than 20 years. Finnish engineer Matti Makkonen invented the idea for SMS (Short Message Service) in 1984, making his vision a reality on December 3, 1992 by sending the first message ("Happy Christmas") from a PC to a cell phone. Since then, the technology has evolved immensely, from both a technology standpoint, and in our everyday uses for it. Originally used for person-to-person (P2P) communication, i.e., Sally sends a text message to Betty – mobile messaging now offers tremendous value to businesses for customer and empl...
Oct. 8, 2015 05:30 PM EDT Reads: 233
Can call centers hang up the phones for good? Intuitive Solutions did. WebRTC enabled this contact center provider to eliminate antiquated telephony and desktop phone infrastructure with a pure web-based solution, allowing them to expand beyond brick-and-mortar confines to a home-based agent model. It also ensured scalability and better service for customers, including MUY! Companies, one of the country's largest franchise restaurant companies with 232 Pizza Hut locations. This is one example of WebRTC adoption today, but the potential is limitless when powered by IoT.
Oct. 8, 2015 04:30 PM EDT Reads: 7,472
You have your devices and your data, but what about the rest of your Internet of Things story? Two popular classes of technologies that nicely handle the Big Data analytics for Internet of Things are Apache Hadoop and NoSQL. Hadoop is designed for parallelizing analytical work across many servers and is ideal for the massive data volumes you create with IoT devices. NoSQL databases such as Apache HBase are ideal for storing and retrieving IoT data as "time series data."
Oct. 8, 2015 02:45 PM EDT Reads: 499
Clearly the way forward is to move to cloud be it bare metal, VMs or containers. One aspect of the current public clouds that is slowing this cloud migration is cloud lock-in. Every cloud vendor is trying to make it very difficult to move out once a customer has chosen their cloud. In his session at 17th Cloud Expo, Naveen Nimmu, CEO of Clouber, Inc., will advocate that making the inter-cloud migration as simple as changing airlines would help the entire industry to quickly adopt the cloud without worrying about any lock-in fears. In fact by having standard APIs for IaaS would help PaaS expl...
Oct. 8, 2015 02:30 PM EDT Reads: 655
NHK, Japan Broadcasting, will feature the upcoming @ThingsExpo Silicon Valley in a special 'Internet of Things' and smart technology documentary that will be filmed on the expo floor between November 3 to 5, 2015, in Santa Clara. NHK is the sole public TV network in Japan equivalent to the BBC in the UK and the largest in Asia with many award-winning science and technology programs. Japanese TV is producing a documentary about IoT and Smart technology and will be covering @ThingsExpo Silicon Valley. The program, to be aired during the peak viewership season of the year, will have a major impac...
Oct. 8, 2015 01:00 PM EDT Reads: 262
SYS-CON Events announced today that ProfitBricks, the provider of painless cloud infrastructure, will exhibit at SYS-CON's 17th International Cloud Expo®, which will take place on November 3–5, 2015, at the Santa Clara Convention Center in Santa Clara, CA. ProfitBricks is the IaaS provider that offers a painless cloud experience for all IT users, with no learning curve. ProfitBricks boasts flexible cloud servers and networking, an integrated Data Center Designer tool for visual control over the cloud and the best price/performance value available. ProfitBricks was named one of the coolest Clo...
Oct. 8, 2015 01:00 PM EDT Reads: 764
Organizations already struggle with the simple collection of data resulting from the proliferation of IoT, lacking the right infrastructure to manage it. They can't only rely on the cloud to collect and utilize this data because many applications still require dedicated infrastructure for security, redundancy, performance, etc. In his session at 17th Cloud Expo, Emil Sayegh, CEO of Codero Hosting, will discuss how in order to resolve the inherent issues, companies need to combine dedicated and cloud solutions through hybrid hosting – a sustainable solution for the data required to manage I...
Oct. 8, 2015 01:00 PM EDT Reads: 478
Apps and devices shouldn't stop working when there's limited or no network connectivity. Learn how to bring data stored in a cloud database to the edge of the network (and back again) whenever an Internet connection is available. In his session at 17th Cloud Expo, Bradley Holt, Developer Advocate at IBM Cloud Data Services, will demonstrate techniques for replicating cloud databases with devices in order to build offline-first mobile or Internet of Things (IoT) apps that can provide a better, faster user experience, both offline and online. The focus of this talk will be on IBM Cloudant, Apa...
Oct. 8, 2015 12:45 PM EDT Reads: 509


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Festival fashion: Fringe, denim and color
From camping out to dancing for days under the hot sun, music festivals are not for the faint of heart. Whether you're planning on chilling at Bonnaroo or rocking out at Coachella, you'll need easy, no fuss fashion that still shows off your sense of style. Here, some of our top picks. -- Compiled by Brianna McMahon
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Long Island and New York City's top photos Evolution of LI cheerleaders LI notable deaths Peek inside Long Island's most lavish homes Must-see LI, NYC concerts Lighthouse tour, more fun things to do this week Recent LI mug shots Recent LI fires Meet Long Island's high school mascots LI's Elite 11 football teams Sachem North High School Homecoming 2015 Meet LI's cheerleading and kickline teams


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Articles tagged contest, dan deacon
18 Aug 2015 // 3:41 PM
Stephanie Clifford's new book Everybody Rise is released today and to celebrate we're throwing a contest for a chance to win the book and a Dior addict make-up set.READ more
3 Jun 2015 // 2:11 PM
Enter for your chance to win a copy of Brad Meltzer's new book The President's Shadow + $100 Visa gift card.READ more
7 Jun 2013 // 3:00 AM
Enter our contest for a chance to win a pair of tickets to the Postal Service at the Barclays Center in New York City on June 15th.READ more
3 Jun 2013 // 5:15 AM
Enter our contest for a chance to win a pair of tickets to Ariel Pink's Irving Plaza show in New York City on June 6th. Double your chance to win by "liking" PopMatters on Facebook.READ more
3 Oct 2011 // 6:00 AM
Giveaway of Ocean's Kingdom just in time for its release on October 4th!READ more
2 Jun 2011 // 3:59 AM
POPMATTERS SPONSOR Tone® is turning up their Backstage Pass Artist Series by teaming with Grammy-nominated artist Sara Bareilles. From live chats and an online tourREAD more
26 Jan 2011 // 10:00 PM
Though there has yet to be a single musician or band that can act as a succinct exemplar of Baltimore's sound, Thank You's latest album, Golden Worry, may come closest to summarizing the vibe, spirit, and sonic sensations that have made Baltimore's underground community what it is today.READ more
30 Aug 2009 // 10:00 PM
- //Columns
The media is too preoccupied with the funeral arrangements of the mainstream music industry to celebrate the life that is happening elsewhere.READ more
23 Jul 2009 // 5:30 AM
Noisevox is a new live music site, focused mainly on indie rock and they've come out of the gate with an impressive array ofREAD more
26 Mar 2009 // 10:00 PM
Dan Deacon holds a warped funhouse mirror up to his inner electronic composer. Don't worry, he hasn't matured. Rather, he's evolved.READ more
30 Sep 2008 // 11:00 PM
- //Music
Carpark continues to document Wham City's enchantment with juvenalia, this time taking on some chiptune teenage victory songs.READ more
23 Apr 2008 // 6:10 AM
Les Savy Fav Disco Drive (live) [MP3] In These Woods [MP3] Precision Auto (live) [MP3]READ more
14 Jun 2007 // 10:00 PM
Life can be a bitch at times, and in those moments of angst, you just want to throw it up 'cause you're totally f*READ more
5 Jun 2007 // 11:00 PM
Dan Deacon manages to lure in his audience with his strange, raucous brand of electro-pop and induce them to sway, leap, and even shout along with him.READ more
3 May 2007 // 8:00 AM
Betty Davis Anti Love Song [MP3] He Was a Big Freak [MP3] Buy at iTunesREAD more
Chron Goblin "Give Way" (audio) (premiere) // Music
The Underachievers "Star Signs" x "Generation Z" (Singles Going Steady) // Music
Distant Cousins "Taste of Tomorrow" (audio) (premiere) // Music
Notes, Hoaxes, and Jokes: Silkworm's 'Lifestyle' - "Ooh La La"
// Sound Affects
"Lifestyle's penultimate track eases the pace and finds fresh nuance and depth in a rock classic, as Silkworm offer their take on the Faces' "Ooh La La".READ the article


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3:3–5 James uses metaphors from common experience to illustrate his cardinal point that great results can be achieved by small means. The tongue is a small part of the body that is capable of creating great disasters.


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GameFAQs User Profile: supernova54321
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Posts tagged with Health Insurance
City to consider covering domestic partners as part of city's health insurance plan; commissioners now qualify for city coverage, thanks to Obamacare
Lawrence city commissioners soon will get to weigh in on the issue of domestic partnerships versus traditional marriages.
After digging through a few more documents related to the city's proposed budget, I found a memo detailing changes to the city's health insurance plan. One recently implemented change and one proposed change caught my eye. The recently implemented change: City commissioners are now eligible to be on the city's health insurance plan. (More on that in a moment.) The proposed change: Staff members are recommending that domestic partners of city employees be eligible to join the city's health insurance plan, just as spouses of city employees are eligible.
Lori Carnahan, human resources manager for the city, said several city employees have been asking about the availability of a domestic partner benefit. The city recently conducted a survey of its employees, and of the 146 respondents, 30 percent said they would use the domestic partner benefit.
"It is an issue that my colleagues in the human resources industry have discussed the concept of for probably six to eight years," Carnahan said. "But the discussion really has been increasing over time."
Obviously there are several large, international private companies that offer domestic partnership benefits. But I'm not sure how many area governments have adopted the practice. Douglas County approved a similar health plan benefit for domestic partners in 2011.
As far as the logistics of this go, the city is well-positioned to deal with it. In May 2007, Lawrence became the first city in the state to create a domestic partnership registry. The registry allows domestic partners — both gay and heterosexual couples — to file paperwork with the city clerk's office that provides evidence they are living in a true domestic partnership. The registry then can be used by insurance companies to verify that a domestic partnership exists.
The city will use that registry to verify domestic partnerships involving city employees. The registry requires that partners share a common permanent residence, have agreed to be in a "relationship of mutual interdependence," both "contribute to the maintenance and support of the household," are not married to a third individual or are a member of a domestic partnership with a third individual, are 18 years or older, have the mental capacity to enter into a contract and are not related by blood in any way that would prevent a marriage in the state.
Carnahan said the city's insurance plan manager — the city is technically self-insured but hires a professional company to help manage the operation — has said the change is not expected to create any increased underwriting costs. The city will have to comply with a federal law that does not allow insurance premiums of domestic partners to be paid for with pre-tax dollars — married couples can have their premiums deducted from their paychecks before taxes. But Carnahan said the city has the necessary software to accomplish the task.
Now all that is left is to determine whether city commissioners have an interest in creating the new policy. Commissioners will get briefed on insurance issues at today's budget study session, which begins at 3:30 p.m. But commissioners don't take formal actions at study sessions, so I would expect the issue to come up at a future City Commission meeting.
Beginning June 1, city commissioners became eligible to enroll in the city's health insurance program. They have the Affordable Care Act — or Obamacare — partially to thank for that.
City commissioners previously had not been eligible for the health care benefit because they are not considered full-time city employees. But the Affordable Care Act mandates that large employers generally offer health insurance to employees who average 30 hours per week for a year.
Do city commissioners work 30 hours per week? Well, that's tough to say because city commissioners don't punch a time clock.
Carnahan said her staff decided that making city commissioners eligible for the health care benefit would be the safest way to ensure the city was in compliance with the new federal law.
It is unclear how many commissioners may take advantage of the new benefit, but it is a significant benefit.
If a city commissioner wanted to insure just himself, it would cost only $5 per pay period — or $130 per year — to be covered under the city's plan, which is considered to be a good one. That's the same rate all city employees pay for single coverage.
Commissioners also can choose to have their families and spouses covered under the plan. Those rates — which are the same for all city employees — range from $69 a pay period to $118 per pay period, depending on the type of coverage.
City commissioners currently receive a $9,000 per year salary, while the mayor receives a $10,000 per year salary. However, commissioners in April said they wanted to have a discussion about possibly raising those salary levels.
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- Former KU basketball great Bill Bridges dies at age of 76 October 8, 2015
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- Just Food board alleges Farmer overpaid himself by more than $52,000; criminal charges being pursued September 16, 2015
- U.S. Supreme Court justices appalled by details of Kansas murder cases October 7, 2015


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Publications (122)361.85 Total impact
Article: Kaatsu training to enhance physical function of older adults with knee osteoarthritis: Design of a randomized controlled trial[Show abstract] [Hide abstract]
ABSTRACT: As the U.S. population ages, efficacious interventions are needed to manage pain and maintain physical function among older adults with osteoarthritis (OA). Skeletal muscle weakness is a primary contributory factor to pain and functional decline among persons with OA, thus interventions are needed that improve muscle strength. High-load resistance exercise is the best-known method of improving muscle strength; however high-compressive loads commonly induce significant joint pain among persons with OA. Thus interventions with low-compressive loads are needed which improve muscle strength while limiting joint stress. This study is investigating the potential of an innovative training paradigm, known as Kaatsu, for this purpose. Kaatsu involves performing low-load exercise while externally-applied compression partially restricts blood flow to the active skeletal muscle. The objective of this randomized, single-masked pilot trial is to evaluate the efficacy and feasibility of chronic Kaatsu training for improving skeletal muscle strength and physical function among older adults. Participants aged≥60years with physical limitations and symptomatic knee OA will be randomly assigned to engage in a 3-month intervention of either (1) center-based, moderate-load resistance training, or (2) Kaatsu training matched for overall workload. Study dependent outcomes include the change in 1) knee extensor strength, 2) objective measures of physical function, and 3) subjective measures of physical function and pain. This study will provide novel information regarding the therapeutic potential of Kaatsu training while also informing about the long-term clinical viability of the paradigm by evaluating participant safety, discomfort, and willingness to continually engage in the intervention. Copyright © 2015. Published by Elsevier Inc.Contemporary clinical trials 06/2015; 43. DOI:10.1016/j.cct.2015.06.016 · 1.94 Impact Factor
Article: Development of a Review of Systems Screening Tool for Orthopaedic Physical Therapists: Results From the Optimal Screening for Prediction of Referral and Outcome (OSPRO) Cohort[Show abstract] [Hide abstract]
ABSTRACT: Study Design Literature review and cross-sectional study. Objective To describe the development of a review of systems screening tool appropriate for use by orthopaedic physical therapists. Background Direct access to physical therapy necessitates greater responsibility to determine appropriateness of care by recognizing the potential for concomitant disease or systemic involvement. Recent research has identified excessive variability in reporting of red flag symptoms. An initial step to improving identification of red flag symptoms is the development of a standardized screening tool. Methods First, a red flag symptom item bank was compiled from a systematic literature review to allow for further psychometric testing and development of a screening tool. Second, physical therapists in 11 outpatient clinics recruited patients presenting with primary complaints of neck, shoulder, low back, or knee pain. Patients completed the red flag symptom item bank and standard questionnaires for comorbidities, negative mood, quality of life, pain, and function. The development of the screening tool involved identifying and combining different three-item sets that characterized the highest number of patients reporting at least one positive symptom response (operationally defined as "red flag symptom responder"). Results The literature search yielded 103 studies meeting inclusion criteria and the final item bank consisted of 97 items representing 8 body systems. 431 patients with primary complaints of neck (n=93), shoulder (n=108), low back (n=119), or knee (n=111) disorders contributed to the cross-sectional study. The number of red flag symptom responders was 393/431 (91.2%). These patients were older, more likely to be female, had lower income, and were more likely to report neck or back pain (all P values < 0.05). A 10 item review of systems screening tool correctly identified 372/393 (94.7%) and a 23 item version identified 393/393 (100%) of responders. The review of systems screening tools and the complete 97 item bank had similar correlations with concurrent clinical measures, except for depressive symptoms. Conclusions Concise red flag symptom identification appears to be feasible in outpatient orthopaedic physical therapy settings. Future research will determine how this review of systems screening tool needs refinement for different patient populations and whether it predicts clinical outcomes or the need for referral to other providers. J Orthop Sports Phys Ther, Epub 21 May 2015. doi:10.2519/jospt.2015.5900.05/2015; 45(7):1-32. DOI:10.2519/jospt.2015.5900
Article: Implications of early and guideline adherent physical therapy for low back pain on utilization and costs[Show abstract] [Hide abstract]
ABSTRACT: Initial management decisions following a new episode of low back pain (LBP) are thought to have profound implications for health care utilization and costs. The purpose of this study was to evaluate the impact of early and guideline adherent physical therapy for low back pain on utilization and costs within the Military Health System (MHS). Patients presenting to a primary care setting with a new complaint of LBP from January 1, 2007 to December 31, 2009 were identified from the MHS Management Analysis and Reporting Tool. Descriptive statistics, utilization, and costs were examined on the basis of timing of referral to physical therapy and adherence to practice guidelines over a 2-year period. Utilization outcomes (advanced imaging, lumbar injections or surgery, and opioid use) were compared using adjusted odds ratios with 99% confidence intervals. Total LBP-related health care costs over the 2-year follow-up were compared using linear regression models. 753,450 eligible patients with a primary care visit for LBP between 18-60 years of age were considered. Physical therapy was utilized by 16.3% (n = 122,723) of patients, with 24.0% (n = 17,175) of those receiving early physical therapy that was adherent to recommendations for active treatment. Early referral to guideline adherent physical therapy was associated with significantly lower utilization for all outcomes and 60% lower total LBP-related costs. The potential for cost savings in the MHS from early guideline adherent physical therapy may be substantial. These results also extend the findings from similar studies in civilian settings by demonstrating an association between early guideline adherent care and utilization and costs in a single payer health system. Future research is necessary to examine which patients with LBP benefit early physical therapy and determine strategies for providing early guideline adherent care.BMC Health Services Research 04/2015; 15(1). DOI:10.1186/s12913-015-0830-3 · 1.71 Impact Factor
Article: Concordance and discordance between measured and perceived balance and the effect on gait speed and falls following stroke[Show abstract] [Hide abstract]
ABSTRACT: To ascertain the existence of discordance between perceived and measured balance in persons with stroke and to examine the impact on walking speed and falls. A secondary analysis of a phase three, multicentered randomized controlled trial examining walking recovery following stroke. A total of 352 participants from the Locomotor Experience Applied Post-Stroke (LEAPS) trial. Participants were categorized into four groups: two concordant and two discordant groups in relation to measured and perceived balance. Number and percentage of individuals with concordance and discordance were evaluated at two and 12 months. Walking speed and fall incidence between groups were examined. Perceived balance was measured by the Activities-Specific Balance Confidence scale, measured balance was determined by the Berg Balance Scale and gait speed was measured by the 10-meter walk test. Discordance was present for 35.8% of participants at two months post stroke with no statistically significant change in proportion at 12 months. Discordant participants with high perceived balance and low measured balance walked 0.09 m/s faster at two months than participants with concordant low perceived and measured balance (p < 0.05). Discordant participants with low perceived balance and high measured balance walked 0.15 m/s slower than those that were concordant with high perceived and measured balance (p ⩽ 0.0001) at 12 months. Concordant participants with high perceived and measured balance walked fastest and had fewer falls. Discordance existed between perceived and measured balance in one-third of individuals at two and 12 months post-stroke. Perceived balance impacted gait speed but not fall incidence. © The Author(s) 2015.Clinical Rehabilitation 03/2015; DOI:10.1177/0269215515578294 · 2.24 Impact Factor
Article: The Profile of Long-term Parkinson's Disease Survivors with 20 Years of Disease Duration and Beyond[Show abstract] [Hide abstract]
ABSTRACT: Background: Parkinson's disease (PD) patients with 20 years or more survival (PD-20) are not well characterized. Objective: To evaluate PD-20 patient characteristics and identify areas for improvement of their health care. Methods: The international, multicenter National Parkinson's Foundation Quality Improvement Initiative (NPF-QII) study database was queried to identify PD-20 subjects. Demographic and clinical data were analyzed. Results: We identified 187 PD-20 subjects (55% men) representing 4% (187/4,619) of all NPF-QII participants. Subjects were mean age 69.5 years; mean age at PD onset was 44.0 years. The majority (75%) had 20-25 years of PD duration, the longest duration being 49 years. They were median Hoehn and Yahr stage 3, and 75% had motor fluctuations. Half (54%) reported exercising. The majority (89%) were living at home and required a caregiver (88%). They were mildly cognitively impaired for age (Montreal Cognitive Assessment estimate 22.6 ± 3.7), with most deficits in verbal fluency and delayed recall. Quality of life (Parkinson's Disease Quality of Life Questionnaire index 36 ± 15%) was mild to moderately impaired, with most impairment in mobility and activities of daily living. Caregiver strain measured by the Multidimensional Caregiver Strain Index (27 ± 16%), recorded highest subscores in social constraint. PD-20 subjects aged <70 years versus ≥$70 only differed significantly by worse cognition (P < 0.0001). Conclusions: PD-20 subjects reflect an elite group of PD survivors with early-onset disease and relatively mild cognitive disability despite long disease duration. Interventions for caregivers, mobility, and activities of daily living are areas that could improve caregiver burden and patient quality of life.Journal of Parkinson's Disease 02/2015; 5(2). DOI:10.3233/JPD-140515 · 1.91 Impact Factor
Article: Biopsychosocial influence on shoulder pain: risk subgroups translated across preclinical and clinical prospective cohorts[Show abstract] [Hide abstract]
ABSTRACT: Tailored treatment based on individual risk factors is an area with promise to improve options for pain relief. Musculoskeletal pain has a biopsychosocial nature, and multiple factors should be considered when determining risk for chronic pain. This study investigated whether subgroups comprised genetic and psychological factors predicted outcomes in preclinical and clinical models of shoulder pain. Classification and regression tree analysis was performed for an exercise-induced shoulder injury cohort (n = 190) to identify high-risk subgroups, and a surgical pain cohort (n = 150) was used for risk validation. Questionnaires for fear of pain and pain catastrophizing were administered before injury and preoperatively. DNA collected from saliva was genotyped for a priori selected genes involved with pain modulation (COMT and AVPR1A) and inflammation (IL1B and TNF/LTA). Recovery was operationalized as a brief pain inventory rating of 0/10 for current pain intensity and <2/10 for worst pain intensity. Follow-up for the preclinical cohort was in daily increments, whereas follow-up for the clinical cohort was at 3, 6, and 12 months postoperatively. Risk subgroups comprised the COMT high pain sensitivity variant and either pain catastrophizing or fear of pain were predictive of heightened shoulder pain responses in the preclinical model. Further analysis in the clinical model identified the COMT high pain sensitivity variant and pain catastrophizing subgroup as the better predictor. Future studies will determine whether these findings can be replicated in other anatomical regions and whether personalized medicine strategies can be developed for this risk subgroup.Pain 01/2015; 156(1):148-56. DOI:10.1016/j.pain.0000000000000012 · 5.21 Impact Factor
Article: Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS[Show abstract] [Hide abstract]
ABSTRACT: To study mood and behavioral effects of unilateral and staged bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for Parkinson's disease (PD). There are numerous reports of mood changes following DBS, however, most have focused on bilateral simultaneous STN implants with rapid and aggressive post-operative medication reduction. A standardized evaluation was applied to a subset of patients undergoing STN and GPi DBS and who were also enrolled in the NIH COMPARE study. The Unified Parkinson Disease Rating Scale (UPDRS III), the Hamilton depression (HAM-D) and anxiety rating scales (HAM-A), the Yale-Brown obsessive-compulsive rating scale (YBOCS), the Apathy Scale (AS), and the Young mania rating scale (YMRS) were used. The scales were repeated at acute and chronic intervals. A post-operative strategy of non-aggressive medication reduction was employed. Thirty patients were randomized and underwent unilateral DBS (16 STN, 14 GPi). There were no baseline differences. The GPi group had a higher mean dopaminergic dosage at 1-year, however the between group difference in changes from baseline to 1-year was not significant. There were no differences between groups in mood and motor outcomes. When combining STN and GPi groups, the HAM-A scores worsened at 2-months, 4-months, 6-months and 1-year when compared with baseline; the HAM-D and YMRS scores worsened at 4-months, 6-months and 1-year; and the UPDRS Motor scores improved at 4-months and 1-year. Psychiatric diagnoses (DSM-IV) did not change. No between group differences were observed in the cohort of bilateral cases. There were few changes in mood and behavior with STN or GPi DBS. The approach of staging STN or GPi DBS without aggressive medication reduction could be a viable option for managing PD surgical candidates. A study of bilateral DBS and of medication reduction will be required to better understand risks and benefits of a bilateral approach.PLoS ONE 12/2014; 9(12):e114140. DOI:10.1371/journal.pone.0114140 · 3.23 Impact Factor
Article: Likelihood of myocardial infarction during stroke rehabilitation preceded by cardiovascular screening and an exercise tolerance test: The Locomotor Experience Applied Post-Stroke (LEAPS) Trial[Show abstract] [Hide abstract]
ABSTRACT: Background Coronary artery disease is highly prevalent in patients with stroke, but because revascularization does not improve major clinical outcomes in patients with stable coronary artery disease relative to intensive medical therapy, routine evaluation for this disease is not warranted in stroke patients. However, it might be warranted in patients destined to undergo vigorous physical therapy. The Locomotor Experience Applied Post-Stroke study, a randomized controlled trial of 408 participants that tested the relative efficacy of two rehabilitation techniques on functional walking level, provided the opportunity to address this question.AimThe study aims to test the efficacy of screening for cardiovascular disease and an exercise tolerance test in assuring safety among patients undergoing vigorous rehabilitation for gait impairment.Methods All participants were screened for serious cardiovascular and pulmonary conditions. At six-weeks poststroke, they also completed a cardiovascular screening inventory and underwent an exercise tolerance test involving bicycle ergometry. Participants received 36, 90-min sessions of a prescribed physical therapy (three per week), initiated at either two-months or six-months poststroke.ResultsTwenty-nine participants were excluded on the basis of the cardiac screening questionnaire, and 15 failed the exercise tolerance test for cardiovascular reasons. No participant experienced a cardiac event during a treatment session. Two participants experienced myocardial infarctions, but continued in the trial. In three additional participants, myocardial infarctions caused or contributed to death.Conclusions The combination of a negative cardiac screen and the absence of exercise tolerance test failure appeared to have a high negative predictive value for cardiac events during treatment, despite the likelihood of a high prevalence of coronary artery disease in our population.International Journal of Stroke 09/2014; 9(8). DOI:10.1111/ijs.12354 · 3.83 Impact Factor
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ABSTRACT: Adaptive design of clinical trials has attracted considerable interest because of its potential of reducing costs and saving time in the clinical development process. In this paper, we consider the problem of assessing the effectiveness of a test treatment over a control by a two-arm randomized clinical trial in a potentially heterogenous patient population. In particular, we study enrichment designs that use accumulating data from a clinical trial to adaptively determine patient subpopulation in which the treatment effect is eventually assessed. A hypothesis testing procedure and a lower confidence limit are presented for the treatment effect in the selected patient subgroups. The performances of the new methods are compared with existing approaches through a simulation study. Copyright © 2014 John Wiley & Sons, Ltd.Statistics in Medicine 07/2014; 33(16). DOI:10.1002/sim.6127 · 1.83 Impact Factor
Article: Does quadriceps neuromuscular activation capability explain walking speed in older men and women?[Show abstract] [Hide abstract]
ABSTRACT: Age-related impairment of neuromuscular activation has been shown to contribute to weakness in older adults. However, it is unclear to what extent impaired neuromuscular activation independently accounts for decline of mobility function. The hypothesis of this study is that capability to produce rapid neuromuscular activation during maximal effort leg muscle contractions will be shown to be an independent predictor of mobility function in older men and women after accounting for muscle size and adiposity, body composition and age. Twenty six older men and eighteen older women (aged 70-85 years) participated in this study. Mobility function was assessed by the 400-meter walk test. Neuromuscular activation of the quadriceps muscle group was assessed by surface electromyography ("rate of EMG rise"). Thigh muscle cross sectional area and adiposity was assessed by computed tomography. In males, univariate regression analysis revealed strong associations between walking speed and a number of predictors including age (p < 0.01), muscle area (p < 0.01), intermuscular adipose tissue area (p < 0.01), and rate of EMG rise (p < 0.001). Subsequent multiple regression analysis with all variables accounted for 72% of the variability in walking speed (p < .0001), with age and rate of EMG rise as the dominant variables in the model. In females, univariate analysis showed a significant association only between walking speed and subcutaneous adipose tissue area (p < 0.05). Multiple regression analysis accounted for only 44% of the variability in walking speed, and was not statistically significant (p = 0.18). The present findings indicate that the capability to rapidly activate the quadriceps muscle group is an important factor accounting for inter-individual variability of walking speed among older men, but not among older women. This research is important for informing the design of assessments and interventions that seek to detect and prevent impairments that contribute to age-related mobility disability.Experimental gerontology 07/2014; 55. DOI:10.1016/j.exger.2014.03.019 · 3.49 Impact Factor
Article: Cognitive Effects of Treatment of Depression with Repetitive Transcranial Magnetic Stimulation[Show abstract] [Hide abstract]
ABSTRACT: We previously reported a randomized, sham-controlled trial of 5 Hz dorsolateral prefrontal left- and right-side repetitive transcranial magnetic stimulation (rTMS) in 48 participants with a medically refractory major depressive disorder. Depression improved most with right-side cranial stimulation, both rTMS and sham, and to a lesser degree with left rTMS. Because depression is often associated with cognitive impairment, in this study we sought to determine whether our earlier participants had treatment-induced changes in cognition, which cognitive domains (language, executive, visuospatial, verbal episodic memory, attention) were affected, and whether treatment-induced cognitive changes were related either to improvement in depression or to other treatment variables, such as right versus left treatment and rTMS versus sham.Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology 06/2014; 27(2):77-87. DOI:10.1097/WNN.0000000000000031 · 0.95 Impact Factor
Article: A Pilot Randomized Controlled Trial of D-cycloserine and Distributed Practice as Adjuvants to Constraint-Induced Movement Therapy After Stroke[Show abstract] [Hide abstract]
ABSTRACT: Phase III trials of rehabilitation of paresis after stroke have proven the effectiveness of intensive and extended task practice, but they have also shown that many patients do not qualify, because of severity of impairment, and that many of those who are treated are left with clinically significant deficits. To test the value of 2 potential adjuvants to normal learning processes engaged in constraint-induced movement therapy (CIMT): greater distribution of treatment over time and the coadministration of d-cycloserine, a competitive agonist at the glycine site of the N-methyl-D-aspartate glutamate receptor. A prospective randomized single-blind parallel-group trial of more versus less condensed therapy (2 vs 10 weeks) and d-cycloserine (50 mg) each treatment day versus placebo (in a 2 × 2 design), as potential adjuvants to 60 hours of CIMT. Twenty-four participants entered the study, and 22 completed it and were assessed at the completion of treatment and 3 months later. Neither greater distribution of treatment nor treatment with d-cycloserine significantly augmented retention of gains achieved with CIMT. Greater distribution of practice and treatment with d-cycloserine do not appear to augment retention of gains achieved with CIMT. However, concentration of CIMT over 2 weeks ("massed practice") appears to confer no advantage either.Neurorehabilitation and neural repair 04/2014; 28(9). DOI:10.1177/1545968314532032 · 3.98 Impact Factor
Article: Prediction of responders for outcome measures of Locomotor Experience Applied Post Stroke trial[Show abstract] [Hide abstract]
ABSTRACT: The Locomotor Experience Applied Post Stroke rehabilitation trial found equivalent walking outcomes for body weight-supported treadmill plus overground walking practice versus home-based exercise that did not emphasize walking. From this large database, we examined several clinically important questions that provide insights into recovery of walking that may affect future trial designs. Using logistic regression analyses, we examined predictors of response based on a variety of walking speed-related outcomes and measures that captured disability, physical impairment, and quality of life. The most robust predictor was being closer at baseline to the primary outcome measure, which was the functional walking speed thresholds of 0.4 m/s (household walking) and 0.8 m/s (community walking). Regardless of baseline walking speed, a younger age and higher Berg Balance Scale score were relative predictors of responding, whether operationally defined by transitioning beyond each speed boundary or by a continuous change or a greater than median increase in walking speed. Of note, the cutoff values of 0.4 and 0.8 m/s had no particular significance compared with other walking speed changes despite their general use as descriptors of functional levels of walking. No evidence was found for any difference in predictors based on treatment group.The Journal of Rehabilitation Research and Development 04/2014; 51(1):39-50. DOI:10.1682/JRRD.2013.04.0080 · 1.43 Impact Factor
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ABSTRACT: The pain experience has multiple influences but little is known about how specific biological and psychological factors interact to influence pain responses. The current study investigated the combined influences of genetic (pro-inflammatory) and psychological factors on several pre-clinical shoulder pain phenotypes. An exercise-induced shoulder injury model was used, and a priori selected genetic (IL1B, TNF/LTA region, IL6 single nucleotide polymorphisms, SNPs) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, kinesiophobia) factors were included as the predictors of interest. The phenotypes were pain intensity (5-day average and peak reported on numerical rating scale), upper-extremity disability (5-day average and peak reported on the QuickDASH instrument), and duration of shoulder pain (in days). After controlling for age, sex, and race, the genetic and psychological predictors were entered separately as main effects and interaction terms in regression models for each pain phenotype. Results from the recruited cohort (n = 190) indicated strong statistical evidence for the interactions between 1) TNF/LTA SNP rs2229094 and depressive symptoms for average pain intensity and duration and 2) IL1Β two-SNP diplotype and kinesiophobia for average shoulder pain intensity. Moderate statistical evidence for prediction of additional shoulder pain phenotypes included interactions of kinesiophobia, fear of pain, or depressive symptoms with TNF/LTA rs2229094 and IL1B. These findings support the combined predictive ability of specific genetic and psychological factors for shoulder pain phenotypes by revealing novel combinations that may merit further investigation in clinical cohorts, to determine their involvement in the transition from acute to chronic pain conditions.Medicine and science in sports and exercise 03/2014; 46(10). DOI:10.1249/MSS.0000000000000328 · 3.98 Impact Factor
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ABSTRACT: Background Spinocerebellar ataxia type 10 (SCA10) is caused by an expansion of a normally polymorphic ATTCT repeat within intron 9 of the ATXN10 gene. Interrupting sequences in the expanded ATTCT repeat track are postulated to be a disease modifier, but are not fully characterized in SCA10 patients. AimAs the large size and the repetitive nature of the SCA10 expansion does not make it amenable for Sanger or next-generation sequencing, we need an alternative approach to determine whether there are interrupted repeat motifs within the SCA10 expansion. Method We developed a strategy that combines long-range PCR and shot-gun sequencing to characterize interruption sequences without full assembly of entire disease allele. We chose three SCA10-positive individuals with disparate clinical presentations and examined the resulting sequences for interrupting motifs. ResultsWith this strategy, we found both known heptanucleotide (ATTTTCT and ATATTCT) and pentanucleotide (ATCCC and ATCCT) interruption sequences in one allele. Additionally, we found novel pentanucleotide (ACTCT, ATTCA, ATTCC) and heptanucleotide (ATTCTCT) repeat interruption motifs in two additional samples. Conclusion Our results demonstrate the utility of this approach for determining the internal repeat structure of difficult to sequence repeat expansions. Furthermore, we find that the extent and type of interrupting sequences varies dramatically between these three SCA10-positive individuals.This article is protected by copyright. All rights reserved.02/2014; 2(2). DOI:10.1111/ncn3.78
Article: Response and Prediction of Improvement in Gait Speed From Functional Electrical Stimulation in Persons With Poststroke Drop Foot[Show abstract] [Hide abstract]
ABSTRACT: To describe changes in and predictors of comfortable gait speed (GS-C) in persons with stroke after 42 weeks (w) using a foot drop stimulator (FDS, Bioness L300™) DESIGN: Secondary analysis of prospective assessments SETTING: Multicenter clinical trial PARTICIPANTS: 99 subjects >3 months post-stroke with GS-C <0.8m/sec and drop foot with a mean age of 60.7y and time post-stroke of 4.8y. GS-C was assessed at baseline and 30w with and without FDS (therapeutic effect) and 6w, 12w, 30w, 36w and 42w with FDS (total effect.) After 8 physical therapy sessions, FDS was used for ambulation over 42w. Changes in mean GS-C over time, FDS "responder" status defined as either >0.1m/sec gain GS-C [the minimal clinically important difference (MCID)] or advancing by one Perry Ambulation Category (PAC), and adverse events (AE) RESULTS: 74 (75%) and 69 (70%) of 99 subjects completed assessments at 30w and 42w, respectively. Baseline GS-C was 0.42m/sec without and 0.49m/sec with FDS. GS-C improved to 0.54m/sec at 30w without FDS (effect size = 0.75) and .54, .55, .58, .60 and .61m/sec at 6w, 12w, 30w, 36w & 42w with FDS, respectively (effect size 0.84 at 42w.) Half achieved a maximum GS-C by 12w. About 18% were PAC and 29% MCID responders for 30w therapeutic effect and 55% were PAC and 67% MCID responders for 42w total effect. After logistic regression, younger age, faster baseline GS-C and Timed Up and Go and balance emerged as the strongest predictors of FDS responders. At 42w, 60% reported a device-related AE with 92% mild and 96% anticipated. GS-C with FDS improved progressively over 42w with >50% achieving a clinically meaningful 42w total effect and 50% achieving a maximum GS-C by 12w. Younger patients with higher mobility levels may benefit most. AE were frequent, mild and reversible.PM&R 01/2014; 6(7). DOI:10.1016/j.pmrj.2014.01.001 · 1.53 Impact Factor
Article: Biopsychosocial Influence on Exercise-Induced Injury: Genetic and Psychological Combinations Are Predictive of Shoulder Pain Phenotypes[Show abstract] [Hide abstract]
ABSTRACT: Chronic pain is influenced by biological, psychological, social, and cultural factors. The current study investigated potential roles for combinations of genetic and psychological factors in the development and/or maintenance of chronic musculoskeletal pain. An exercise-induced shoulder injury model was used, and a priori selected genetic (ADRB2, COMT, OPRM1, AVPR1 A, GCH1, and KCNS1) and psychological (anxiety, depressive symptoms, pain catastrophizing, fear of pain, and kinesiophobia) factors were included as predictors. Pain phenotypes were shoulder pain intensity (5-day average and peak reported on numerical rating scale), upper extremity disability (5-day average and peak reported on the QuickDASH), and shoulder pain duration (in days). After controlling for age, sex, and race, the genetic and psychological predictors were entered as main effects and interaction terms in separate regression models for the different pain phenotypes. Results from the recruited cohort (N = 190) indicated strong statistical evidence for interactions between the COMT diplotype and 1) pain catastrophizing for 5-day average upper extremity disability and 2) depressive symptoms for pain duration. There was moderate statistical evidence for interactions for other shoulder pain phenotypes between additional genes (ADRB2, AVPR1 A, and KCNS1) and depressive symptoms, pain catastrophizing, or kinesiophobia. These findings confirm the importance of the combined predictive ability of COMT with psychological distress and reveal other novel combinations of genetic and psychological factors that may merit additional investigation in other pain cohorts. Interactions between genetic and psychological factors were investigated as predictors of different exercise-induced shoulder pain phenotypes. The strongest statistical evidence was for interactions between the COMT diplotype and pain catastrophizing (for upper extremity disability) or depressive symptoms (for pain duration). Other novel genetic and psychological combinations were identified that may merit further investigation.The journal of pain: official journal of the American Pain Society 01/2014; 15(1):68-80. DOI:10.1016/j.jpain.2013.09.012 · 4.01 Impact Factor
- Journal of Neurosurgery 10/2013; 119(4):1075-1075. · 3.74 Impact Factor
Article: Response.Journal of Neurosurgery 10/2013; 119(4):1075. · 3.74 Impact Factor
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ABSTRACT: Background: Measures of central pain processing like conditioned pain modulation and suprathreshold heat pain response (SHPR) have been described to assess different components of central pain modulatory mechanisms. Central pain processing potentially plays a role in the development of postsurgical pain, however, the role of conditioned pain modulation and SHPR in explaining postoperative clinical pain and disability is still unclear. Methods: Seventy-eight patients with clinical shoulder pain were included in this study. Patients were examined before shoulder surgery, at 3 months, and 6 months after surgery. The primary outcome measures were pain intensity and upper extremity disability. Results: Analyses revealed that the change score (baseline- 3 mo) of fifth pain rating of SHPR accounted for a significant amount of variance in 6-month postsurgical clinical pain intensity and disability after age, sex, preoperative pain intensity, and relevant psychological factors were considered. Conclusions: The present study suggests that baseline measures of central pain processing were not predictive of 6-month postoperative pain outcome. Instead, the 3-month change in SHPR might be a relevant factor in the transition to an elevated 6-month postoperative pain and disability outcomes. In patients with shoulder pain, the 3-month change in a measure of central pain processing might be a relevant factor in the transition to elevated 6-month postoperative pain and disability scores.The Clinical journal of pain 09/2013; 30(9). DOI:10.1097/AJP.0000000000000029 · 2.53 Impact Factor
Top Journals
Nova Southeastern University
Флорида, New York, United States
- Department of Physical Therapy
University of Florida
Gainesville, Florida, United States
- • Department of Biostatistics
- • Department of Physical Therapy
- • Department of Occupational Therapy
- • Department of Statistics
Weill Cornell Medical CollegeNew York City, New York, United States
Duke UniversityDurham, North Carolina, United States
McKnight Brain InstituteGainesville, Florida, United States
Florida Department of HealthTallahassee, Florida, United States
University of North Carolina at Chapel Hill
North Carolina, United States
- Department of Medicine
U.S. Department of Veterans AffairsWashington, Washington, D.C., United States
United States Department of Veterans AffairsБедфорд, Massachusetts, United States


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Men's Downlight® StormDown® Jacket$229.00-$249.00 $171.75-$186.75
Men's Mainstay Insulated Trench Coat$199.00-$219.00 $149.25-$164.25
Men's Cascade Falls Sherpa-Lined Mock-Neck Jacket$80.00-$90.00 $64.00-$72.00
Men's Contour Performance Slub Hoodie$60.00-$70.00 $45.00-$52.50
Men's Voyager II 1/4-Zip Pullover$60.00-$70.00 $45.00-$52.50
Men's Signature Twill Relaxed Fit Long-Sleeve Shirt - Pattern$50.00-$55.00 $37.50-$41.25
Men's Eddie's Signature Thermal Crew Shirt$40.00-$45.00 $30.00-$33.75
Men's Signature Cotton Henley Sweater$60.00-$70.00 $45.00-$52.50
Men's Mountain 5 Pocket Pant - Straight Fit$70.00-$80.00 $52.50-$60.00
Men's Greenpoint Long-Sleeve Shirt$70.00-$80.00 $52.50-$60.00
Men's Versatrex® Long-Sleeve Ripstop Shirt$60.00-$70.00 $42.00-$48.00
Men's Cascade Falls Sherpa-Lined Hoodie$80.00-$90.00 $64.00-$72.00
Men's Lookout 1/4-Zip Mockneck$50.00-$55.00 $30.00-$33.00
Men's Eddie's Signature Thermal Henley$45.00-$50.00 $33.75-$37.50
Men's Feather Edge Leather Belt$50.00 $37.50
Men's Daybreak IR Fleece Jacket$149.00-$169.00 $111.75-$126.75
Men's Signature Twill Relaxed Fit Long-Sleeve Shirt - Solid$45.00-$50.00 $33.75-$37.50
Men's Signature Cotton 1/4-Zip Sweater - Solid$60.00-$70.00 $45.00-$52.50
Men's MicroTherm® StormDown® Jacket - Print$199.00-$219.00 $149.25-$164.25
Men's Contour Performance Crew$55.00-$60.00 $41.25-$45.00


text: dear friends , i am a high school student.. i and my friend are supposed to do an investigatory project on chemistry. our topic is on food adulteration.. we finished the experiment on adulteration of milk. we are supposed to present 10 - 12 pages of relevant information on food adulteration. i have surfed enough through the net ( i guess ) for these information, but i haven't got any satisfactory results. it wud be kind of u to help me on this issue. please. if u can advise me with some web pages or other sources . thank u fawaz


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The Sisters of Loretto marked their 200th anniversary earlier this year, and on Aug. 26, the Rev. Joseph Kurtz, Archbishop of Louisville, will continue that celebration with a Mass and dinner at St. Augustine Church in Lebanon.
The recognition will include the Sisters of Loretto, anyone who served with them and those students who attended schools staffed by the sisters.
The Mass is scheduled for 4 p.m. Aug. 26 at St. Augustine Church with a catered meal to follow in the parish center.
Youth Explosion
First Baptist Church on N. Depot Street invites everyone to attend their Youth Explosion from 3-8 p.m. Saturday, Aug. 11. There will be many different activities and a DJ. There will be a break from 5-6 p.m. for refreshments.
Missionary Day
First Baptist Church on N. Depot Street invites you to their Mission Day program at 3:30 p.m. Sunday, Aug. 12. Rev. Mike Ash, pastor of Mount Union Baptist Church in Summerville, will be the guest speaker.
Summer revival
This past January, St. Catharine College inaugurated its School of Graduate Studies by enrolling 14 students in its master's degree in leadership program with two areas of concentration: community and regional leadership, and health promotion and leadership. Most students took three courses in the spring semester and took from one to three courses this summer.
Campbellsville University gave 14 students the experience of getting ahead in their college career even before starting their freshman year.
Fourteen incoming freshmen participated in the Summer Educational Experience (SEE) program which "allows students to increase their readiness for college level academics, as well as gain insight into the college experience," Kristen Jorgenson, coordinator for introductory studies, said.
Jesus Berlanga, a native of Saltillo, Mexico, who recently moved to Lebanon, poses with Clawz, Campbellsville University's mascot. Berlanga was at Campbellsville University for L.I.N.C. Orientation, July 13-14, and is attending Campbellsville University this fall. L.I.N.C. allows students to make friends and get acquainted with campus before moving in at the end of August.
My first Kentucky garden was in 1974, and it was a humdinger. My husband Walt Rose and I had bought a Troy-bilt tiller in anticipation of our move to Kentucky from Illinois, and we worked up a huge garden area on the only flat piece of land we had. I'll bet it was at least a quarter acre.
We had spent the previous winter pouring through seed catalogs, ordering enough for five families. We even ordered some trees, and our house was in the middle of the woods!
I saw the strangest thing the other day: a bona fide whirlwind? I was taking water to the ewes and lambs mid-day and I looked up to see this swarm of plant material, and whatever else was in it, swirl around a viburnum. It was hot out and only the slightest breeze was apparent.
By David Kessler
Marion County Extension Agent for Agriculture and Natural Resources
What a good week we had with the weather! More rain, some of it of the steady variety, has improved many of our pastures and hayfields. Soybeans and tobacco are looking better, although we have had some get blown down by wind, and corn looks good although we cannot do anything about the corn that didn't pollinate due to the heat.
The Kentucky Master Gardener Program is set to begin at the Washington County Extension Office on Wednesday Sept. 5, at 9 a.m. until noon. We will meet each Wednesday morning through mid-November.
Copyright © 2015
The Lebanon Enterprise is your source for local news, sports, events, and information in Marion County and Lebanon, KY, and the surrounding area.


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Mindy Hawkins and Zachary Miles of Worthville would like to announce the birth of their son, Landen Chase Miles, born Nov. 19, 2012, at Norton Suburban Women's Pavilion in Louisville, Ky. He weighed 8 pounds 4 ounces and was 20 inches long.
Mariah, 7, and Rayden Hawkins, 3 and Layla Miles, 4, helped welcome their brother home.
Maternal grandparents are Nick and Diana Riley of Sanders, Ky. and maternal great-grandmother is Mollie Colston of Carrollton.
Well folks, here we are in the doldrums of winter. The holidays have passed, hopefully happy ones for all of us, and now we are looking forward to spring. We all long for the warm days when the birds will be singing, days we know are around the corner. Enough of the heavy coats and slick roads. Even I, who rarely wears a coat, am tired of wearing one!
Deidra Harlow and Jimmy Hays of Ghent would like to announce the birth of their son, Channing Jaxton Hays, born Nov. 29, 2012, at Norton Suburban Hospital, in Louisville, Ky. He weighed 8 pounds 5 ounces and was 20 inches long.
Maternal grandparents are Lesa and Greg Barr of Carrollton.
Paternal grandparents are Tina and Tony Meadows of Carrollton and Linda and Dan Hays of Louisville.
Shelter In Place is a safety procedure designed to help protect residents of Carroll County and their family during a serious airborne hazardous materials emergency.
It means taking shelter inside the home until the danger has passed. The goal of Shelter In Place is to prevent contaminated outside air from entering the home for the duration of the incident.
Tax forms will be prepared free, Saturday, Feb. 9, from 9 a.m. until 4 p.m. at the Carroll County Neighborhood Center, 1302 Highland Ave. in Carrollton.
Call (502) 732-5253 for a personalized appointment time.
Kroger in Carrollton is holding their annual Cutie Pie contest. Children ages birth to three years of age are eligible. Bring in the child's photo with name, age and phone number on the back. Kroger shoppers will then vote for their favorite Cutie Pie until the close of the contest on Feb. 14. Trophies will be awarded to first, second and third place for both girls and boys. Winners will be announced Feb. 15.
All proceeds go to Relay for Life American Cancer Society. For more information call (502)347-9742.
Do you take your children shopping? This can be the perfect opportunity to help your child develop language skills.
There are many fun activities to do with younger children at the store to help them with language and reading skills.
The store is a great place for teaching new words and for introducing your child to new people and places. You can turn the time you have together into a valuable way to teach language skills to your child. Just remember to make it fun and to pick a time when neither you nor your child is hungry or tired.
January is an extremely important "checkpoint" in spring heifer-development programs.
The key to proper heifer development lies in understanding the factors that influence conception in yearling heifers.
One key factor regulating heifer fertility is age at puberty. Most producers do not consider age at puberty of their heifers to be a major problem, yet few know how many heifers are actually cyclic at the beginning of the breeding season.
In 2001, a large task force of men and women in the Catholic Church began to be well-trained to educate people in our church about child sexual abuse.
Once this task force was equipped, all adults who had any contact with children or youth in church programs were required to take the course called "Protecting God's Children," to have a background check and to faithfully read a monthly bulletin provided on line about child sexual abuse for as long as their ministry involved children or youth.
Copyright © 2015
The News-Democrat is your source for local news, sports, events, and information in Carroll County, KY and the surrounding area.